=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275791303
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HONGBO LIU M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2008
-----------------------------------------------------
Last Update Date | 07/08/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19016 STONE OAK PKWY STE 220
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78258-3281
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-402-1222
-----------------------------------------------------
Fax | 210-402-1224
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19016 STONE OAK PKWY STE 220
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78258-3281
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-402-1222
-----------------------------------------------------
Fax | 210-402-1224
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | P5102
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207XS0117X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery of the Spine Physician
-----------------------------------------------------
License Number | P5102
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------